Slashdot Mirror
My Genome, My Self?
theodp writes "After baring his DNA for the world to see, Steven Pinker follows up in the NYT Magazine with his take on the coming era of consumer genetics. Pinker comes away less wide-eyed than Time Magazine about the current predictive ability of $399 genetic tests, but is convinced enough to opt out of learning whether he has a gene that increases the risk of Alzheimer's and believes that genetic-testing-for-the-masses may hasten the arrival of national health insurance ('piecemeal insurance is not viable in a world in which insurers can cherry-pick the most risk-free customers'). Pinker believes that personal genomics is just too much fun to ban, but for now suggests: 'if you want to know whether you are at risk for high cholesterol, have your cholesterol measured; if you want to know whether you are good at math, take a math test.'"
The thing is, you seem to parse the words and glean some meaning, but the thing is, you miss the point entirely.
Health insurance is a way of sharing risk, a form of solidarity. It is based on the insight that nobody is at fault for certain ailments, so in a society which wants to give the same basic opportunities to everybody, it is our duty to help those who, through no fault of their own, are burdened with sickness or injury. Making people with unfavorable genetic dispositions pay a higher price for health insurance is the opposite of the purpose of health insurance.
That this article will be tagged GATTACA.
All reasons aside, if you get a genetic test right now, you're screwed. Why?
There is no genetic rights. Businesses can exclude you from working for them due to it. Health insurance can disclaim all the "bad gene" illnesses, that is if they accept you at all. The government can pidgeonhole you in some god-awful plan in which you cannot escape.
And if you hide the fact that you were tested, or hide the test results, you are committing insurance fraud, or can be dismissed, with prejudice, for withholding vital employer facts.
And you thought poppy roll buns and drug tests were bad...
Sure, health insurance as a business model is viable when businessmen can eliminate risk from the insured pool. It just isn't viable as a way to care for a society. I think that's the point that was being made. Costs are distrubuted in insurance because you get a very wide pool of people involved, and everybody pays in. OTOH, if you get genetic segregation of health insurance plans, you have only very risky people in a particular pool, and they all have to pay very high rates. If they can't afford that, then you wind up with a bunch of people dead, which is a higher cost to society than a few extra dollars for insurance.
I agree that most people aren't interested in "health insurance." People want health. Health care, medical care, to be healthy. Health insurance is just a particular way to try and reduce the potentially extreme personal costs of getting health. And, once you get a completely nationalised health system, you effectively have a system equivalent to insurance with the largest possible pool. You pay taxes instead of premiums, but the risk is distributed through the entire society, so the people with the lowest risk probably pay slightly more as tax, but the people with the highest risk pay substantially less. (Of course, that assumes that the *for profit* health insurance companies don't actually make a profit any higher that the cost of government stupidity, while in practice the profits of doing health insurance tend to be enormous. This is likely an invalid assumption, no matter how cockheaded the government implementation is.)
Perhaps what you said is true for a co-op, in which everybody in the co-op does for each other.
However, if we talk about the USA Medical Insurance companies, they exist for pure profit and nothing else. If they fail to treat you within the allotted time, you die. Shucks... guess we keep your money you paid for insurance services.
That's a lovely thought! However, Solidarity and the like is not the equitable transfer of a risk of a loss from one entity to another in exchange for a premium. (that is to say, insurance). It is, however, some expression of socialism. Whether or not this is a desirable thing is a function of your political philosophy on such matters.
The World Wide Web is dying. Soon, we shall have only the Internet.
For example, what good would "normal" cancer test be if it detected 100% of cancer cases, but also, for every one detected, falsely marked 3 others as having cancer when they didn't.
Now apply it to this.
Kevin Smith on Prince
In theory insurance is about customers sharing the burden of risk, not insurance companies raising their profits by mitigating risk. In practice, it's exactly the opposite.
It gives plenty of outward clues as to "what makes a person tick", which we internalize over a lifetime as "rules."
An example FTFA:
Stick him in a room with 9 non-Quebecers, and a native Quebecer will pick him out immediately. He "looks" like a michigan-hotdog+poutine-looer
So this gives a quick insight into his formative culture (since it gives information about BOTH nature and nuture - genes have regional variations), despite his rejection of the interviewers' observation.
That he rejected something so obvious just goes to show that we're all human, and want to believe that we're more complex than we really are.
Kevin Smith on Prince
Socialism is the concept that the means of production are owned and controlled by the state (communism: by the people). Solidarity is the individual or collective desire to help someone with their problems. The concepts couldn't be more different.
Health insurance is a result of solidarity insofar as the sick and injured couldn't institute and sustain a health insurance system on their own. The system depends on people with good health mixing their low risk with the high risk of other people. If you separate the low risk people from the high risk people, health insurance can no longer serve its primary function.
Insurance, after all, is about mitigating risk, and a fuller knowledge of one's exposure to risk is a good thing.
MEDICAL insurance is, to most people, actually all about being able to afford medical treatment. Knowing your "risk" in this situation unfortunately can often only lead to you being denied coverage and subsequently NOT afford the services you need more.
It is, however, some expression of socialism.
Now that the Republican Party is passing out of power in the US we can expect that there will be a good deal less socialism, so whether or not it is desirable (I believe mostly not) there is going to be a good deal less of it now that the more liberal Democratic Party is in control.
I've never been clear exactly WHY Americans call their Socialist Party "the Republican Party". This is the party that has overseen massive growth in government both in responsibilities and costs, intrusive imposition of the federal government into areas normally reserved for the states or the people, and huge transfers of risk "in solidarity" from private individuals and organizations to the public.
It has capped all of this by actually taking ownership of significant parts of your financial system, which must in today's world be counted as firmly amongst "the means of production." Now that the liberal Democratic Party is replacing the socialist Republican party perhaps free market solutions will be prescribed for some of the things that ails the US, like allowing badly-run businesses that make products no one wants to FAIL.
Blasphemy is a human right. Blasphemophobia kills.
Nothing like cutting edge 21st century technology to bring the US roaring into step with 20th century social attitudes. Way to keep up guys.
It's funny, you say that like we all got together and foolishly decided that private health insurance was the best way to go, rather than special interests setting up camp directly opposed to what is better for everyone else.
Since we're going to play that game, good job on setting up the government corruption in (insert your home country here).
'piecemeal insurance is not viable in a world in which insurers can cherry-pick the most risk-free customers'
Piecemeal insurance is not viable under any circumstances. It's the profit part of the equation that borks everything: when your money depends on not paying out benefits, you're going to do whatever you can get away with to not pay out benefits. Private, for-profit health insurance makes even less sense than private, for-profit fire departments, police forces and armies.
A-Bomb
How are a bunch of dead high genetic risk individuals costly to society?
Health insurance is a scam pushed on the masses through Federal tax loopholes. You don't need health insurance for MOST of your health care needs. I have health insurance for BIG stuff, hence me HUGE deductible (5 figures). I pay very little for health care, going to a cash-only doctor who asks for an up front fee annually for unlimited visits and some basic yearly lab tests. He doesn't even take insurance, Medicare, or credit cards. He's also available for house calls.
Genetic testing for predispositions will likely give people options to fight the parts of those possible diseases that nurture (lifestyle) causes, instead of just pure nature (genetics). As more people are prediagnosed, it is wise for insurers to drop them. Here's the thing, though: if insurers drop too many peoole, doctors will have to find ways to treat them, or the doctors will be out of work.
The number of doctors leaving the world of insurance and Medicare are growing. It's a good thing. They can treat you cheaply ($35 per visit, cash on the barrel), and can spend time with you helping you make choices to work towards a healthier life. It's not about taking drugs, sometimes, it's about fighting the diseases before they're serious. MANY diabetics could have prevented the disease had they known they had a predisposition. Not all, I understand, but many (see: fat diabetics). The same is true of other diseases.
As more people lose health insurance and find options for cheaper health care (it is out there, really), genetic testing will make it easier for us to work with our doctors to find ways to avoid the tragedies. We're not healthy people, because we rely on health insurance rather than preliminary lifestyle adjustments before we get sick.
Wash your hands after touching sick people. Cut back on excessive drinking and smoking. Wear a condom. Don't eat too many sugars or starches. Do some exercise. It's not so hard.
The big late-age diseases, Parkinson's and Alzheimer's, are great to diagnose risks early. Then you can SAVE YOUR MONEY when you're young to prepare for the care you'll need when you're old. Don't pass it off to insurers, save for it yourself.
Or are you too busy buying the latest video games or blowing it on a weekend of drinking that you won't remember in 6 months?
Harshly worded, perhaps, but I didn't mean it as a troll.
Why on earth should society deliberately hobble itself supporting people with severe hereditary disease? Never mind the fact that people with these diseases who have children are exceptionally (and unacceptably) selfish.
Just because the dawn of eugenics saw racists trying to justify their views doesn't mean the concept itself is bad.
Besides, once germline genetic engineering is A) possible and B) permitted to fix genetic disease, the problem goes away anyway.
The thing is, you seem to parse the words and glean some meaning, but the thing is, you miss the point entirely.
Not entirely unlike human genomic research :)
And, once you get a completely nationalised health system, you effectively have a system equivalent to insurance with the largest possible pool.
Actually, no, because there is virtually no risk involved: EVERYONE gets sick, and EVERYONE dies, and about half of EVERYONE's health care costs come in the last six months of life.
Although costs vary, they don't vary by that much, although the tail of the distribution is long. See figure B1 in this report on Canadian health care costs to see the actual distribution. For something over 70% of the population the average cost of a single hospital stay is less than $10,000, and virtually everyone has a couple of those stays in their lifetime (I've had one despite being in extremely good health generally.)
This is utterly unlike true insurance models--auto, home and term life--where the majority of people who pay premiums never collect a claim.
It is interesting to note that both the Canadian and American health care systems use insurance models, and suffer from similar problems of access and spiralling costs. I believe this is due to the inherent inappropriateness of an insurance model for a service that everyone will need and everyone which has a relatively low variance of total payouts.
A reasonable model of health insurance would deal with catastrophic costs only, say in excess of $10,000 per hospital stay as indicated by these data. As not everyone falls into that category, one could actually use insurance to spread RISK, which is not really possible under an "everyone pays, everyone benefits" model because the tails are not that relevant to the overall cost of the system, so you basically have a situation where there is very little risk to be spread (closer analysis of the numbers could contradict that, but that's my impression from a first look.)
Blasphemy is a human right. Blasphemophobia kills.
Why on earth should society deliberately hobble itself supporting people with severe hereditary disease?
Because this is Earth, and that's what civilized people on Earth do.
Never mind the fact that people with these diseases who have children are exceptionally (and unacceptably) selfish.
Judging from your comic-book villain logic, you're no model of human evolution yourself.
Yes, because if you have cystic fibrosis, or thalasemia, or huntington's... it's perfectly acceptable to deliberately have children knowing they have a 50% chance of a shortened lifespan with some terrible suffering.
I know people on both sides - one couple that was unaware they were carriers of a nasty resessive gene who both got 'fixed' upon the diagnosis of their firstborn, and another couple where the wife had a 50% chance of being a carrier (she was not old enough to be past the point of the first symptoms) who had the money to get tested but had children WITHOUT getting tested because she didn't want to know she shouldn't have kids. Nice, eh?
I'm not suggesting that kids not get coverage, but that anyone with a nasty genetic disease who has kids get cut off. Insurance isn't for those who deliberately cause their own misfortune, it's for those who get caught unaware.
How are a bunch of dead high genetic risk individuals costly to society?
If one is predisposed to Parkinsons or something, which wouldn't manifest itself until late middle age, a car accident ( as early 20 year olds are prone to ) could make the difference between a successful multi-billion dollar CEO of something that benefits society ( who later dies of parkinsons ) and a bankrupt service sector wage slave ( who later dies of parkinsons )
"A reasonable model of health insurance would deal with catastrophic costs only, say in excess of $10,000 per hospital stay as indicated by these data."
That wouldn't work, because it takes away the motivation to reduce risk to everyone for the lower-cost events. Less reason for the "insurer/halth care system" to encourage people to do preventative care that has a low risk of falling into the "catastrophic" category.
As we're seeing with the GM bankruptcy, a single health-care system has unforeseen side benefits, one being that GM wouldn't be in its' current position if it didn't have $110 billion of unfunded health-care liabilities.
Kevin Smith on Prince
Hoo boy! You didn't read the article, did you. Reading the 8 long pages takes a while, given that the language isn't designed for the illiterate. I'd recommend page 5.
The basic message is simple - the DNA tests are slightly better than horseshit, and nowhere near as good as talking to some gossipy individual (prejudices and all) who knows you and your family. He quotes horrible stats like a study of 16,000 people for DNA contribution to IQ which managed to explain 2% of the variance. So if you are going to spend $400 to $100,000 per individual on outcome info, the best way to do it is to pay dear old ladies to babble to someone typing into a database. Saying things like, "Yeah, that family were often off to the library and that's why he had to get glasses aged 14." Such a database would be a huge heap of social venom but it would work better than genome testing.
The downside is that it would lack the aura of technology and be difficult to persuade funding for.
There are a few rare conditions worth testing for, but those are in the main an irrelevancy. They are rare, and usually the family history is already really informative.
If you don't want your tax dollars going to needless medical costs, then genome testing is not a good approach. Try persuading people not to eat high salt fatty food. Pay for TV ads for this. It will be a total waste of time, but so is playing with eugenics. At least you will know in advance that you are wasting your dollars.
The Dirty Little Secret is this. Everyone has a price tag. Be it from the private sector, or public Government.
Tell me, would both of these entities spend $1,000 to save your life? Cool. What about a Million? How about a Billion? Would they dare spend a Trillion on your life?
The moment you start negotiating the price for a single human being (in whole or in part) is the moment the argument still stands. We ALL have a price tag on our life.
So, what's the big deal about Insurance companies making a profit. Immoral yes, but also to be expected.
Life is not for the lazy.
If you can test "in utero", you can have your cake and eat it too. If the fetus is going to result in a disaster, a quick D&C is preferable to a lifetime of crap.
Of course, this has social implications - the biggest one being that, over time, the average "genetic quality" of "true believers" - fundies who are against abortion, will trend lower than the population at large. Considering some of the mouth-breathing, knuckle-dragging moronics displayed in the last election, we've already gotten to the point where the effect is visible.
3-4 more generations ... it'll sort itself out. Just keep telling yourselves that God really wants you to breed kids that will live a shortened, painful, and meainingless life. Stupidity, like intelligence, is partly genetic.
Kevin Smith on Prince
1. Prenatal genetic testing.
2. Genetic counseling for prospective parents.
3. Actuarial estimate of lifetime healthcare costs at birth.
4. Mandatory front-loaded health savings accounts, funded by income withholding, until the amount saved in the account is equal to the amount necessary until end-of-life medical care, based on actuarial estimates.
5. Parents pay into the account until the child reaches adulthood, then the person covered continues until the account is fully funded.
6. Account holders can use their health savings account on any recognized treatment required, but reimbursement is limited to the rate set by the government. For example, if the limit is $5000 for a particular treatment, and the patient spends $10,000, the remainder is paid by the patient directly. This prevents draining the account, either by unscrupulous doctors or by fraud.
7. Shortfalls for necessary treatment are covered by the government, but treated as a loan with interest.
8. Money left in the account is passed on to heirs, while shortfalls are taken out of the estate in probate. Any remaining shortfall is covered by the government and paid through taxes.
9. Actions that increase medical risks (obesity, smoking, excessive drinking) are handled by increased payment into the health savings account. Actions that decrease risks, such as maintaining healthy weight and regular checkups result in lower amounts withheld for the account. Actions that benefit the community -- organ donor cards, blood donation, willing their body to medical science, etc -- get a bonus put into their account.
Of course, this won't happen as long people prefer to pass healthcare costs to the next generation in budget deficits, rather than paying for their own care.
Woosh. Every country does, and it's not that the citizens choose it, just as we in the US didn't decide to go with for-profit health insurance.
Now, i don't wear a tin foil hat but this discussion sounds like this crazy book i got for Xmas.
Insurance IMHO is like gambling, you and them bet you might or might not get sick and one you pays for the mistake. National healthcare is a good thing for a lot of people right now considering our situation.
I'm here for the experience, not the Hyperbole.
Let's say insurance companies only chose the healthy ones, or rather made it cheaper for healthy (genetically speaking) people to get insurance and a lot more expensive for genetically "ill" people.
The immediate result is that 80% of the genetically ill people can't afford the insurance, and 80% of the genetically healthy people decide not to buy insurance (after all, they've done the test and they know they're in a low-risk group).
Net result: insurance company loses.
I thought this was the way it worked in general, which is why insurance companies would only go so far in separating people into groups and charging according to cost to the insurer.
And what happens when everybody with the name of Bob is deemed statistically dangerous to society?
These sorts of thigns aren't viable because it's difficult to draw a line as to when it's safe to remove rights of an individual. Therefore we default to giving everybody equal rights.
I mean statistically speaking Black Men should be put under far more close surveilance than white women. They're going to statistically cause more crime. But once you decide something like that you've also said that we shouldn't allow men to drive cars because they're more likely to crash. This goes far beyond 'slippery slope' this is a non slope. You can't find a slope the moment you begin assigning different rules to different groups of individuals based on innate and highly suspect reasoning.
Part of the reason our mental health care is sooooo terrible in this country is because of the abuse it received not very long ago. Unhappy with your wife and want her 'gone'. Inform the court that she's mentally unstable and in need of psychiatric care. She'll deny it but that's just part of the paranoia lock her up! The burden of proof for psychiatric lock up in extraordinary because it involves removing the rights of an individual that has commited no crimes or threatened society.
In schools should we offer a genetic test for intelligence and success and give resources to students based on the probability they're going to succeed?
I used to work as a contractor for the George Church lab. My supervisor was a student of Church's. Church was his boss. I was working on bio-informatics (if anyone cares, I can tell you some tricks for regexp-searching of genetic sequences).
My family was under extreme financial duress. In light of that knowledge, my supervisor (tells me, at least) that he took my situation to George and they came up with this: "Sign up to be one of the first 10 PGP subjects. Give us all of your medical records from the past and into the future. Agree to have your sequence published. We think we can get Harvard to agree to pay for your medical insurance for life. Don't you think your family deserves for you to make that trade-off?"
I said, flatly, "no." I pointed out, among other problems, some severe technical problems in the line of sequencing research we working on. Ultimately, we (me and the lab) part ways on less than amicable terms after this.
I think these people are scum.
They were eager to exploit my poverty as leverage to make me a human subject to rather dangerous experimentation based on highly dubious scientific claims - and they punished me for dissenting from this plan, as nearly as I can tell.
-t
I am young and in good health. Right now, I could not afford a $10k hospital stay -- yes, eventually I could save up for it, but right now I can't. I can, however, afford an insurance premium that will cover it. As mentioned, I'm young and in good health, so that premium isn't terribly pricey. What would you have me do?
Wow, because you called me illiterate, I'm convinced of your opinion!
Just a suggestion, if you're really trying to convince people, name calling is a pretty good way to get them to tune you out, and thus isn't recommended. Another hint... people participating in a text-based format can probably read and write and are therefore literate by definition.
Family history is a good way to choose what tests to perform, but if the tests are inexpensive enough, you might as well test for everything. And family history can tell you you're at risk for having a specific genetic flaw, but only a DNA test can tell you that you actually inherited it.
Article or not, most of your opinion is just dead wrong in the context of the discussion at hand.
Genetic testing offers a great number of benefits, and some pretty (dire) consequences too, if it's not used Ethically.
Fortunately most Genetic testing is medically vetted/requested. The old Doctors Hippocratic Oath, theoretically means it would only be used when Medically sensible.
Part of the biggest problem faced with this type of technology/research is the "I don't want to know" factor combined with paranoia about Eugenic ideology. I've read articles by stupid misinformed Journalists describing Geneticists as "The Devil's Messengers" - of course based off that I tend to think "Well, then Physicists must be the Devil himself!".
My opinion, is that the research should continue, however under regulation (as happens currently), and that private interest (corporations) be prevented from developing tests and or technology that could be used to discriminate and differentiate amongst individuals in one of the worst ways imaginable... the worst thing we can do is run off half-cocked and start preaching the benefits of technologies not yet ready.
Disclaimer: Just my (somewhat-unhumble) opinion. I am NOT a Molecular Biologist, but I do have some understanding in this area.
A Man's ethical behavior should be based effectually on sympathy, education, and social ties -- Albert Einstein
I'll just show up with my steel-clad genes and live an extremely unhealthy life style, then use my health insurance funds to undo the damage. Take THAT "the system"!
Help fight spam
>I have health insurance for BIG stuff, hence me HUGE deductible (5 figures).
Bullshit.
Im only 33 and need insurance. My sleep apnea machine costs a few thousand dollars. No "emergency" insurance covers that, yet SA is as serious as anything else. Toss in the sleep studies and my insurance probably paid out 6 or 8 grand. I would have lost all my savings and more if I had "emergency" insurance only.
I used to be poorer and had no insurance and pretty much begged doctors for the "cash rate." All my medicines were samples. I barely scraped by and I got lucky. I was young and healthy. No major accidents. Now in my 30s I cannot do that. No way.
You sure as hell are not having a baby safely by paying cash. No emergency insurance is going to cover pre-natal, delivery, post-natal, etc.
>Wash your hands after touching sick people. Cut back on excessive drinking and smoking. Wear a condom. Don't eat too many sugars or starches. Do some exercise. It's not so hard.
Yeah, youre a moron. I do all these things. Kids born with diabetes arent going to exercise it away. Youre not going to fix a broken leg with happy thoughts. Not eating a twinkie doesnt cure a MRSA infection. Not drinking beer doesnt fix a rotted tooth.
>Then you can SAVE YOUR MONEY when you're young to prepare for the care you'll need when you're old.
My dad's CPOD and Alzheimer's treatments are in the 5 digits. In 10 years its going to be well over 500,000. Thats a lot to save on top of retirement.
How old are you? Some college student who has yet to grow up and see how your body falls apart when youre older? Its all downhere from here. If all of Europe can do national healthcare then so can we. Dont let being "college liberatarian" make you more ignorant than you already are of health matters.
Dude, you're full of shit. $35/visit, eh? Ya. So assuming the doctor's day is full of patients (no gaps) and each "visit" is 30 minutes the doctor makes $70/hr. Now you add in business taxes and he makes ~$50/hr, maybe less. Then you factor in office space and ... oh fuck he's losing money and we haven't even factored in equipment, supplies, other staff (let's face it if his day is full of patients he's going to need at least one receptionist), etc, etc, etc.
Now as to saving for your own medical care. That's nice and all but unrealistic. For one everyone has high medical costs when they are old. But only say a quarter of the population is going to have a real need for major medical treatment before they are old. And guess what... Those who are unfortunate to need such medical treatment are likely to be needing well over $100,000 in services. The average *FAMILY'S* income in the US is what $45,000/yr. I'll let you do the math on that one.
"shouldn't have kids?"
do you think your friends with cystic fibrosis should not have been born? who are you to impose your judgments on these people?
it's not immoral to have kids knowing they *might* have a disease, nor is it immoral to not have kids for the same reason. if the second couple had gotten the testing and it turned out positive, should they then have been barred from having kids? your assumption is that such offspring can have no contribution to society, that because someone has a disease and will live a shorter and more painful life that they have no worth. sure you save them all that suffering but they'll also never have joy. and if the fact that they wont be born makes them not ever knowing joy a moot point, well then it also makes the pain and suffering moot. does all that suffering outweigh any joy they might have during their lives? would they even view it as suffering?
you'd advocate people lose their insurance simply for procreating, not even with a check to see if the child was born with the *costly* disease first. costly, that's really what you're arguing. you realize that, right? for you to argue that a life filled with lots of suffering has to be meaningless is just insane. i have a friend who has cystic fibrosis (well not exactly but it's something very close) he's got one of the most fulfilling lives i can think of. he has no fear of doing anything he thinks would be fun because he realizes how little time he's got to cram it all in. would you ask someone like that if they should not have been born if his parents knew he *might* be born with this disease?
if you think people should not be born into a life of suffering, lets start with abusive homes first. parents who are going to senselessly beat their kids, or sexually molest them. these families have a much greater cost to society than people with genetic diseases.
There is no genetic rights. Businesses can exclude you from working for them due to it. Health insurance can disclaim all the "bad gene" illnesses, that is if they accept you at all. The government can pidgeonhole you in some god-awful plan in which you cannot escape.
Why don't you lie a bit more and spread some more FUD?
There is ALREADY LEGISLATION AGAINST THIS!!!
A Man's ethical behavior should be based effectually on sympathy, education, and social ties -- Albert Einstein
Your argument is based on someone magically existing even before conception. It's kind of a wacky argument because the logical conclusion is that all possible sperm should be used to fertilize all possible eggs - after all, each fertilized egg is a potential human and we should allow them all life, right?
I'd never say to someone with a nasty disease that they shouldn't have been born. They're real people, getting as much out of life as they can just like everyone else. If they don't exist yet, I'm certainly OK with the concept of preventing the conception of a human with a nasty disease.
The two positions are NOT mutually exclusive.
Actually, I wasn't calling you illiterate. The original article was a really long read with quite complex language at times. It was slow going with a mix of stats and university level English. I had the problem. So my apologies for an inadvertent insult.
On full scan DNA testing: Yes it should be possible within 5 years to get full scans at a reasonable price. If there is a specific DNA fault tied to a particular problem, it will probably find it. (Full I expect to mean mean 1% of the DNA, the 'exome', which I understand generates all the proteins.) Worth doing, I agree, if you can afford it, or if there is a likely (familial) fault and it is worth it for a society to help you avoid propagating a serious problem.
Pinker argued that whilst there are these specific and valid cases, the interpretation of the genetic fitness of an individual is just plain too difficult in the majority of cases. My opinion is that a generation from now it should be different, but the snake oil merchants are not going to wait that long. The valid cases will not pay for them; they will prey on fear and the misunderstandings of statistics. If someone pays $1000 for a test, telling them they do not have any one of 20 rare cases just means they have blown their money. If you go on to elaborate on probabilities and possibilities, then you catch their attention, and they recommend the test to their friends. I dislike what I see as a probable social outcome.
My opinions may be dead wrong, but I am not bothered by that. I express them as a way of having them open for examination, and discarding if need be. Piss on them by all means. But if 'eugenics' is worse than talking to a gossip, I think this comparison should be made clear. Telling people that there is some convoluted statistical correlation that implies they have a potential health problem then they will worry, or alternatively, not employ or insure someone. Say you talked to the local gossip and then trot out the same conclusion and you will be despised. I think there is going to be too much money invested in 'eugenics' to allow people to make rational decisions.
I've been in science, and had to try and explain technology to policy makers who were ignorant of my area, and pretty shaky on even simple stats. In the end, simple comparisons are all that worked. "Eugenics is not as good as talking to your family." That message may undermine billion dollar investments, but I still think it is valid.
On the other hand, I do have a genetic fault that has resulted in a heart op. The DNA link is unknown at present. Long term, yeah it would be nice for family members to know if they have the problem, as it can be better managed than I did in my ignorance. At least when it comes to being dead wrong, the emphasis is still on the wrong.
That isn't the problem. The point is that they agree to accept a monthly payment in exchange for anteing up with MORE money if needed. Statistically they come out on top anyway, unless a plague happens. The problem is when they decide to break their agreement and not keep up their end.
How do you kill that which has no life?
Dude, you're full of shit. $35/visit, eh? Ya. So assuming the doctor's day is full of patients (no gaps) and each "visit" is 30 minutes the doctor makes $70/hr. Now you add in business taxes and he makes ~$50/hr, maybe less. Then you factor in office space and ... oh fuck he's losing money and we haven't even factored in equipment, supplies, other staff (let's face it if his day is full of patients he's going to need at least one receptionist), etc, etc, etc.
Google: Cash Only Doctors. It's a fact. Most doctor visits do not last long. A decent doctor can see 8 patients in an hour for the basic checkup, cold, or other minor ache or pain. I also pay an annual fee that covers joining the clinic.
Some cash-only doctors actually get tips, too. No joke. I know of 2 AAPS doctors that earn more than their annual billing. Most doctors who accept insurance earn far LESS than their annual billing because of the insurance haggling, red tape, and administrative costs.
Now as to saving for your own medical care. That's nice and all but unrealistic. For one everyone has high medical costs when they are old. But only say a quarter of the population is going to have a real need for major medical treatment before they are old. And guess what... Those who are unfortunate to need such medical treatment are likely to be needing well over $100,000 in services. The average *FAMILY'S* income in the US is what $45,000/yr. I'll let you do the math on that one.
Again, you can blame this on insurance and public health programs that drive the cost of medical services up, combined with Congress colluding with the AMA to keep the number of doctors graduating down. It's like education: when government started subsidizing school loans, the cost skyrocketed. Get government out of health care, and education, and the costs will DIVE.
If someone has a great need for medical treatment that is expensive, they use INSURANCE. I tried to find an insurance policy with a $100,000 deductible, but they don't exist. I pay, for EXCELLENT emergency treatment, about 20% of the cost of a typical smoker my age. Why? Because of my high deductible. I buy generics when I need any medication.
The more we create third parties, the more prices go up. It's a simple financial fact.
so while i'm young and healthy now i have to view the money i'm throwing into the system as an investment in what i'll need later in life. my only fear is that our aging population will suck my investment dry so there is nothing left when i need it. aka bastards who never paid into the system but want it all when they are old.
personally i think our model is the best - since i've been in private health from a young age my premiums are lower and any increases will be less for me, vs someone who is 50 and just joined up and will need expensive care within 10 years.
If you mod me down, I will become more powerful than you can imagine....
Where you have to lose to "win".
That's when the game begins because you get to find out that you're gambling against the house and the terms of the wager are usually that if you "win" big they don't have to pay. Nowhere is this more prevalent than health insurance where if you need lifesaving treatment and they deny it, they make a side bet on whether you die before you win the lawsuit. It's a sick, sick game I wish we didn't have to play, but the alternative is to rely on stone-age medicine because the insurance companies have cornered the market on care.
Regardless, Insurance companies use every form of information available to consider their risk and hence the odds (your "premiums" vs your "coverage"). No surprise here; they're not charities. This would obviously include any information about your genetic risks they can get their hands on. I'm confident they're partnered with every genetic lab in the country for "privileged" information sharing, for public health reasons of course. I would be shocked if they didn't require genetic profiling as a minimum standard of care sometime in the next decade.
Get anybody in your family on the wrong list and let your coverage lapse even for a day - and you'll find your entire family in the medical stone age for the rest of your lives. No antibiotics. No X-Rays. No dentistry. Not for you. Not yours.
Help stamp out iliturcy.
So, what's the big deal about Insurance companies making a profit. Immoral yes, but also to be expected.
It's a violation of human rights when they have a monopoly on medical care. We have a right to "life". Even felons are entitled to medical care, but not free people without coverage, and no-one is obligated to cover you, but for most health issues noone will treat you in the US without coverage. Catch-22.
If you don't believe they have a monopoly, perform this experiment: write out a bogus identity on a sheet of paper. Then dial every dentist in your area and try to get an appointment to get an infected tooth extracted sometime in the next six months, but lie and tell them you have no coverage. The result will be instructive. An infected tooth is a life threatening situation you can't get treated in an Emergency room. I know - I've tried.
We need to break the monopoly on coverage for care if we are to have a chance at a humane system.
Help stamp out iliturcy.
I always thought that was funny. Most actuaries value a human life between $750K-$3 million. In the event the shuttle is stranded at the ISS, NASA is willing to spend $500 million for another launch to rescue everyone. I'm NOT saying it isn't worth it, just because if it's me stuck on the ISS, I want every dollar spent to bring me home alive. I am saying you just have to be worried about who is doing the valuing of your life.
Perhaps you can explain how the countries in this documentary (Germany, Japan, Switzerland, etc.) are able to keep healthcare overhead at around 5% (it's around 24% in the USA) while also providing a great deal more services. It's sick really. The US spends the most on healthcare, but ranks 37th out of the 190 on a list of countries based on quality of healthcare.
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
Countries with rockstar healthcare systems: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/
Liberal, conservative, nationalist, federalist, socialist, communist, Democrat, Republican... For the last decade I've come to wonder if these words ever had any meaning at all. Certainly they don't mean the same things I learned about in social studies when Carter was president.
Did I not get the memo? Was there some global polar reversal I missed somewhere? Ok, I'm off topic so mod me down but somebody go AC and answer please.
Help stamp out iliturcy.
As mentioned, I'm young and in good health, so that premium isn't terribly pricey.
I think the point of TFA is that if insurance companies discover you have some genetic predisposition towards expensive treatments, you'll find coverage unavailable at any price. Then what? You can't get treated for cash in the US for anything except emergency care. Don't believe me? Try. The insurance companies have a monopoly on care.
We should all be very afraid.
Help stamp out iliturcy.
Knowing your "risk" in this situation unfortunately can often only lead to you being denied coverage and subsequently NOT afford the services you need more.
It's worse than that. For most people with no coverage, care is unavailable at any price. If you can't endow a wing of a hospital and you have no coverage, you're not getting a new kidney.
Help stamp out iliturcy.
So, what's the big deal about Insurance companies making a profit. Immoral yes, but also to be expected.
There's nothing immoral about it. If anything it's amoral.
Every company exists to make a profit. If there was no profit involved, no insurance companies would exist. Profit is the incentive that allows anyone to be covered in the first place.
"Hi. This is my friend, Jack Shit, and you don't know him." - Lord Kano
He doesn't even take insurance, Medicare, or credit cards. He's also available for house calls.
Lucky you. He's a rare bird indeed. Treat him well. There are not enough of him for the rest of us.
Help stamp out iliturcy.
It's the profit part of the equation that borks everything: when your money depends on not paying out benefits
Everyone seems to think that having something in the government removes the profit motive and really, nothing could be further from the truth. It's only a recent thing that government did not control the exclusive right to all commerce in the western world. Of course government wants to make a profit on something and then misuse them. In fact, on nearly every income stream, from social security set-asides to tobacco trust payments, turnpikes and port authorities, recent government enterprises has been nothing but a profit center with which to blow more money on other things.
This is my sig.
You forget about the part about where people with no coverage get no care at all. Even people with average risks need to get a bone set, an infectious ailment treated with antibiotics now and then. If they have no coverage, what are they to do? Go to Mexico? Have you tried to board a plane with an untreated compound fracture lately? That's a no-fly listing for sure.
This is why the game is crooked. They can choose not to cover you and with no coverage you have no hope for care. That makes genetic testing for unknown but potentially expensive conditions bad for averageman.
Help stamp out iliturcy.
"Bad genes" aren't anything like a 100% predictor of the development of medical conditions. It's not like letting these people die will wipe out sick people, leaving us with a perfectly healthy society. So an awful lot of people who would have lived to a healthy old age will die or go bankrupt because of appendicitis, or injuries sustained playing sports, or any other condition that has nothing to do with their genes. Meanwhile those with no genetic predisposition keep developing cancer and keep getting treated for it despite the fact that this will cost more with much less likelihood of a successful outcome than the kid with the sports injury.
When it comes down to it, allowing people to die in agony without medical treatment is barbaric - I don't believe that's a particularly sentimental position.
A closed mouth gathers no foot.
This is a supply side problem. We have gatekeepers for doctors. We have gatekeepers for medicines. We have gatekeepers for coverage and the coverage is a gatekeeper for care. The gatekeepers are financially motivated. If you fail any gate, you get no care at all. The gates don't just pass/fail, they also rate limit for the the purpose of maintaining the scarcity of medicine and care, and hence drive up the price. The entire system is designed to hide the cost from the end user, so the upward spiral of cost is guaranteed.
Gene testing for actuarially costly predispositions is just a shortcut to "no care".
To have a more humane system we need to remove these gates. We need to have a federal system for doctor approval, and it needs a fast track and a cross training program to channel in displaced workers. We need to get the FDA out of the pocket of big Pharma. We need to neuter the tort system. We need to do not just one, but all of these things, not gradually but all at once. We also need some sort of agreement on what level of medical intervention is socially useful, and what should be diverted to hospice care.
And... it ain't gonna happen. So let's meet back here in a decade and whine about it some more.
Help stamp out iliturcy.
State sponsored means, or State enforced means
It's not just "the state", insurance companies themselves are fucking with the prices. Remember, they want high prices because A) high prices scare people into thinking they need insurance and B) they dictate what they're going to pay anyway, so high prices don't affect them.
To see this in action, consider a fictitious country: some common and uncomfortable disease exists here that costs $1 to treat. A company comes along and says "For $0.90, we'll pay your treatment cost for you!" Half of the people in the country buy the insurance. The insurance company goes to the doctors and says "I have half the people in this country on my insurance plan. You'll treat them for $0.50, or I'll tell them to go to some other doctor and you get nothing." One or two like dada's doctor will say "hell no" and lose half their patients, but most will think "if half of the patients are on the insurance, I can simply charge the patients who aren't 50 cents more to make up the difference.
A year passes, and it's time for everyone to sign a new contract. The insurance company raises its rates to $1.25 and runs ads about the "recent increase in the cost of medicine". Even more people sign up. The insurance company goes to the doctors and tells them that they have 2/3rds of the patients in the country on the insurance plan, and now they're going to pay the doctor $0.30 to treat them. Some doctors drop out, the rest do the math and figure out that to make up for the money they're losing, they'll have to charge the one-in-three uninsured patient $2.40 to make up the difference.
This pattern repeats until setting a simple arm fracture costs the uninsured patient thousands of dollars for what used to be a couple hundred bucks of time and plaster. Eventually most patients are insured and fewer and fewer doctors drop out of the insurance game because they would have to fight over smaller and smaller pools of patients. The price of insurance never appears to be more than the cost of treatment, but only because the apparent cost of treatment is artificially inflated by the insurance company contracts.
It's a monopoly only if the single provider is Government. At least in America, the private system provides choices in the market place.
Personally, I don't care which system you go for be it government, employer provided plan, or what not. The key issue is having choice. I don't want to be forced into only having one option.
Life is not for the lazy.
we simply need non-profit co-operative insurance agencies, that can insure everything... and have a basic oath of conduct saying that no person will ever be denied insurance or care because or genetic disposition, et cetera (AKA non-governmental universal healthcare).
i suggest having statewide agencies... not national ones; so, like credit unions, they can join together as a national association and share their knowledge and abilities as a group but retain their individual charms and local seats of administration.
DON'T CAPITALIZE! CO-OPERATE! AND FREE EVERYTHING!
You have some strange definition of monopoly I've not heard before.
Help stamp out iliturcy.
The front companies provide the illusion of choice, but the American Medical Association holds a monopoly on licensing for conventional care, the drug companies are focused mainly on securing patent monopolies above anything else, and the insurance companies themselves have an army of lobbyists to keep them in their places of privilege.
Note also that neither Clinton nor Obama seriously advocated for a single-payer system during the recent election. Both proposed federal subsidies for existing insurance companies, touting it as the more politically realistic choice. I don't support state-monopolized medicine myself, but I can't see such a proposal as anything other than crackpot realism, which is the first refuge of scoundrels.
How do I find a doctor like this? Are there labs with similar practices? What about things like Xrays, etc? I would love to use health insurance as actual insurance and not as a health plan - but to be honest, I don't know how to do that given the high prices of medical treatment (I agree that these are the result of the universal nature of HMOs and the AMA, but they're still a reality...). So...educate me - how do I do this?
Oh, yes, that's absolutely true. But the parent posts assertion that simply because my premium saved over long enough means I can save up for a $10k hospital bill I can afford to not have insurance against said hospital bill is horribly self-centered... not everyone is in the same financial position he's in.
Hint: government is not there to make profit.
My mother is a dentist in Eastern Europe. They have emergencies like everybody else, when they can't refuse a pacient and most rules about insurance don't work. Back when she worked for the state they had mandatory emergency service 24/24 (I remember she often complained it was very tiring, but better paid). They still have it at bigger hospitals.
I don't know how it is in US, of course.
I truly cannot express how vile, dangerous, pernicious, and inhumane this idea is. Either you didn't think this idea through clearly, or you want to create as much misery as possible.
I'm with you so far.
Here is where your plan starts to smell fishy. How are you supposed to predict lifetime healthcare costs for an individual? We can do it very well statistically, but any given member of a population can differ wildly from the mean. If you try to force an estimate anyway, most of these estimates well be wrong.
We can predict the average error based on the statistical distribution, but the error in any one sample is unknown, and that's a huge problem when we consider the rest of your vile plan:
First of all, "cost" is a fuzzy target. The value of currency is subject to wild flings, and unless you index this cost continuously to inflation, the value of this account becomes progressively more divorced from reality, even more than it was in the first place. If you do index the outstanding balance to inflation, you'll end up causing vast economic damage. The total amount of money going through this system would be huge. To index that to inflation would in turn drive inflation change itself, greatly magnifying the normal fluctuations in the value of money. That economic instability would decrease the efficiency of the system as whole. We already see this problem to some extent in social security payments.
This item has major, negative effects on society too: first, it creates a large disincentive to have children. Government ought to create an incentive to have children, since not only does childrearing perform the obvious function of propagating the next generation, but it promotes healthy, stable societies. Among families that did have children, it'd push many of them into poverty. Do we really need children raised that way? And before you say that parents just won't have children: fact is, they do anyway. And the "do it anyway" crowd belongs to the group that needs the most financial assistance anyway.
Again, your plan magnifies negative phenomena we already see in society.
Another major negative effect of your rotten plan is to grossly skew the income distribution of young people. Not only do you tax what must be a significant portion of their income, but that taxation is regressive: everyone pays the same nominal amount, since (predicted) health does not depend on income. Therefore, the poorer you are, the larger the percentage of your income is paid in health fees. You drive middle class people into the working poor, and you drive the working poor into poverty, and you drive those in poverty to die on the streets. The rich are unaffected.
It's no defense to say that the regressive taxation disappears after some period of adulthood. Social mobility decreases sharply with age, and by the time the taxation disappears, class lines made far sharper by your proposal will already have been drawn.
If you want an analogy, look at student loans. Their often crippling costs act as a drag on the economy is precisely the same way, except that student loans might be progressive: the rich go to more expensive schools, after all.
This mechanism is insufficient barring a monopoly in health insurance. Can't I, a separate insurer, simply offer to charge people only $0.90, and pay doctors $0.35? At some point, equilibrium is reached.
Through competition, the kind of spread you're talking about should be reduced to zero. Either there's rampant collusion (which I'm not dismissing), actual costs are increasing, or there's some other mechanism at work.
Yeah, and that's already paid by government health insurance: Medicare. Once you hit 65, you're on Medicare, not private insurance, so the argument that massive costs occur at the end of life is not really an argument against nationalized healthcare - we already have that portion of it.
I think I see a plot for a japanese hentai manga here :). After all, all the eggs of those young schoolgirls which go to waste need help, so enter... The Fertilizer !
Seriously, it would make more sense than most of those plots ;).
Forget magic. Any technology distinguishable from divine power is insufficiently advanced.
First, let me be up front and say that I think t sucks that we have become a two party government. This has eliminated competition in the place where it is most needed. I doubt our government will ever bring itself up on antitrust charges so I guess we have to make do. I found it amusing to read that the Republicans are socialist because most of the Republicans I know swear that Democrats are socialists. Socialist has become a dirty word that the two parties use to try and stir up hate to hide the fact that both just look for ways to make money off of the people. I do not understand why socialism is viewed so negatively, the worst thing about it in the USA is tha tnothing good is ever socialized.
Double-hint: The government can be elected, moulded, and destroyed, by you.
I think you are mistaken; legislation was passed last year. The Genetic Information Nondiscrimination Act of 2008 prohibits group health plans and health insurers from denying coverage to a healthy individual or charging that person higher premiums based solely on a genetic predisposition to developing a disease in the future.
Same principle as everywhere else -- middlemen may be a convenience in some cases, but generally they serve mainly to increase costs -- after all, they want a cut of the profits too!!
~REZ~ #43301. Who'd fake being me anyway?
A reasonable model of health insurance would deal with catastrophic costs only, say in excess of $10,000 per hospital stay as indicated by these data.
And what happens to those who cannot afford $10,000. Do they deserve to die because they were too stupid or too poor to save up $10,000?
And what if you had saved $10,000, broke your leg and used those $10,000? Now you don't have the $10,000 you need to survive a serious illness for instance.
There are really two types of genetic testing: Informational and Medical. Medical testing is based on large groups of people and controlled study, whereas Informational is just throwing around 'what we think is going on' and is fun to see. I found this site useful to learn more about these differences, and they can even differentiate which tests are right with price comparison: www.AccessDNA.com
It is based on the insight that nobody is at fault for certain ailments,
The problem is that medical insurance covers ailments that ARE the fault of the person. And those ailments are often very expensive. I have a relative who smoked a pack a day since they were a pre-teen, never paid for health insurance, but spent years getting free chemotherapy then free hospice care.
Given that you claim to be young and in good health, the obvious answer would be to take out a loan. Under any reasonable circumstances the terms on a personal loan are bound to be better than the expected return on your monthly insurance premiums.
Insurance has its place, but only in the context of pooling risks. If everyone is expected to endure a $10k hospital stay at some point it isn't really a risk, but rather a known cost, and the tools to deal with known costs are savings and loans.
As for the other common objection, "pre-existing conditions", the solution is to take out insurance before they become "pre-existing". Essentially, you're stuck with making one wager -- that you (or your dependent) might end up with some unforeseen disease or disability -- so you balance it out with a bet on the opposing side, trading risk for cost.
"The state is that great fiction by which everyone tries to live at the expense of everyone else." - Bastiat
I disagree with your fundamental concept of insurance. Insurance is a product for risk management. It allows you to pay directly for your risk, in the form of a premium instead of paying for actual damages from the risk. For this to work... that is for the product to be valuable to consumers, and profitable to insurers, each customer needs to pay for his risk. e.g. in home insurance, if you have a $2mil house, you have a higher risk, because you have a higher potential loss than someone with an average valued house; if you live in a flood zone, you have a higher risk because you have a higher probability of sustaining damages. It has nothing to do with fault. Maybe your house in the flood zone is a family homestead you inherited. It's not your fault you have a higher risk. But you pay for your risk. That's all.
BULLSHIT. The right to life, is the right to not be killed without due process. It is not a right to free medical services.
The right to life, is the right to not be killed without due process.
The right to life I'm talking about in my post above is more about the natural right each of us is endowed with by our creator, and less about those rights enumerated in the US Constitution, which protects only those of us who live under it, and is limited in other ways. We have a Human right to life.
I agree with you about not entitling people to free medical services. That's not my issue at all. There is some basic level of immunisation and treatment that is for the public health and within the domain of stuff that should be automatic, but that's not what we're talking about here.
What I have a problem with is insurance companies creating a monopoly on care so that people who can pay cash can't get care. Doctors who want to practice for cash can't make a living. "Negotiated group discounts" prevent reasonable for-cash prices for medical practices that also accept insurance. That's just wrong in many different ways. If you aren't covered, you can't get care. If you don't belive me: try. You will find the attempt informative. Call around to your local health providers, and try to get care while pretending to not have coverage. In almost every case, they will not talk to you at all.
For what I pay in annual premiums for medical care in some countries I could have my own doctor to wait upon my every sniffle. It's over $1000/month between me and my employer. Are there any doctors in the third world out there who want to live in my basement? It's warm, and we have cable and food. It pays $12k/yr and you'll work maybe 12 hours/yr and the rest of the time is your own. Bring your whole family, I don't care as long as when my family is sick you'll treat us. Maybe I can hook you up with a clinic to work in when you're not busy with your main job, and you can clear $100k or better with $0 overhead. Sure, you're busy in your village or whatever, but hey, could your extended family maybe use US$6,000 a month? Wouldn't that buy a lot of whatever it is your village needs? How is your time better spent?
Help stamp out iliturcy.
Most Socialist states are republics, but few are democracies.
Real Daleks don't climb stairs - they level the building.
Comment removed based on user account deletion
And what happens to those who cannot afford $10,000. Do they deserve to die because they were too stupid or too poor to save up $10,000?
This is exactly the kind of insurance-centric myopia I was trying to point out.
I was giving "a reasonable model of health insurance" in a post that said the insurance model was a lousy fit for health care. I was saying the insurance model is the WRONG ONE.
So rather than asking smug rhetorical questions it would be more productive to suggest a better model for health care provision than the insurance model, which is pretty clearly broken, in part for exactly the reasons you point out.
I would argue that a pooled-cost model rather than a pooled-risk model is the appropriate one, which carries with it the implication of some kind of triage within the system of the kind that over-taxed emergency rooms and long waiting lists provide in Canada. Acknowledging that we are dealing with a pooled-cost system rather than a pooled-risk system might allow us to design a better means of doing this.
The coefficient of variation in health care payouts is only 10 or so, as opposed to insurance models where it is easily over 100. If I have $1 million term life insurance and am paying $1000 per year for it and there are 1000 people who have the same plan with the same insurance company, and on average just one of us dies per year, the coefficient of variation is going to be nearly 1000 (999.49), as the mean payout is $1000 but the standard deviation is basically $1 million.
Insurance schemes work where the coefficient of variation is large. This is not the case for health care. Ergo, insurance schemes do not work for health care. If one wanted to make an insurance scheme for health care, it would have to have a high minimum payout per hospital visit to create a high coefficient of variation, which would introduce the rhetorical issues you raise.
Now that we have that cleared away perhaps you could present an actual argument rather than asking smarmy questions and pointing out the trivially obvious, because doing those things does exactly nothing toward determining the best way of paying for universal health care services.
Blasphemy is a human right. Blasphemophobia kills.